Non-vascular complications of diabetes

Question 1

What populations are most likely to develop a hyperosmolar hyperglycemic state (HHS)?

Answer 1

Occurs almost exclusively in Type 2 DM, elderly and physically impaired or limited access to free water

Question 2

What distinguishes HHS from DKA?

Answer 2

Severe hyperglycemia >600, Hyperosmolality. Develops more insidiously with polyuria, polydipsia, and weight loss several days before hospital admission. Greater degree of dehydration

Question 3

What are the causes of hyperosmolar hyperglycemic state (HHS)?

Answer 3

Catabolic Stress, Insufficient intake of water, Excessive water loss, High sugar intake, Drugs

Question 4

What are the clinical presentations of hyperosmolar hyperglycemic state (HHS)?

Answer 4

polyuria, polydipsia, weight loss, vomiting, tachycardia, hypotension, severe dehydration, seizures, hyperthermia

Question 5

What are the lab findings of hyperosmolar hyperglycemic state (HHS)?

Answer 5

Blood glucose > 600. Serum osmolality >320. Serum Na+ - normal to high (135-145). Serum K+ - normal (4-5). Serum Bicarb >20. pH > 7.3. Ketones – negative. Complicated by thromboembolic events

Question 6

What is the treatment of DKA and HHS?

Answer 6

medical emergencies. IV fluid and electrolyte replacement. Slower rate and greater volume needed for HHS. Insulin replacement starts after rehydration is in progress

Question 7

How does HHS and DKA differ clinically?

Answer 7

to the presence of ketoacidosis and the degree of hyperglycemia

Question 8

What diabetic population is hypoglycemia more common?

Answer 8

type 1 diabetes, Type 1’s suffer an average of 2 episodes of symptomatic hypoglycemia per week.

Question 9

What are the causes of hypoglycemia?

Answer 9

Insulin injections, Oral hypoglycemic agents, Gastroparesis, Hepatic and renal dysfunction, Malnutrition

Question 10

What are the neurogenic symptoms associated with a hypoglycemica episode?

Answer 10

catecholamine-mediated/adrenergic: Tremor, palpitations, and anxiety/arousal. acetylcholine-mediated/cholinergic: sweating, hunger, and paresthesias

Question 11

What are the neuroglycopenic symptoms associated with a hypoglycemic episode?

Answer 11

cognitive impairment, behavioral changes, psychomotor abnormalities, seizure and coma

Question 12

What are the cardiovascular signs associated with a hypoglycemic episode?

Answer 12

diaphoresis, pallor, tachycardia, HTN

Question 13

What causes absent of symptoms of hypoglycemia?

Answer 13

Loss of autonomic warning due to recent antecedent hypoglycemia, prior exercise, or sleep. Autonomic neuropathy due to diminished epi response. Medications like beta-blockers

Question 14

What is the criteria for a hypoglycemic coma and how is it treated?

Answer 14

Unconsciousness lasting more than 30 minutes after plasma glucose is corrected. IV mannitol (40 g as a 20% solution over 20 minutes). Glucocorticoids (e.g., dexamethasone, 10 mg)

Question 15

What is the dawn phenomenon?

Answer 15

high morning blood glucose between 5-9am due to the release of counter-regulatory hormones (cortisol, GH, glucagon)

Question 16

What is the Somogyi Effect?

Answer 16

Rebound Hyperglycemia—Iatrogenic, low sugars in the middle of the night, high sugars in the morning

Question 17

How do you determine whether an early morning high blood sugar level is caused by dawn phenomenon or Somogyi effect?

Answer 17

check blood sugar levels around 2 a.m. to 3 a.m. for several nights. If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it’s likely the dawn phenomenon

Question 18

What defines hypoglycemia in patients without diabetes?

Answer 18

Whipple’s triad: signs and symptoms of hypoglycemias, plasma glucose <60, and resolution of those signs/symptoms after raising plasma glucose

Question 19

What is factitious hypoglycemia?

Answer 19

occurs secondary to the secret use of insulin. plasma insulin is high while C-peptide is low. This applies to nondiabetic patients and those with type II DM, not type I diabetics who always have low C-peptide levels

Question 20

What is included in the triad of DKA?

Answer 20

hyperglycemia, anion gap metabolic acidosis, and ketonemia